Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

{"title":"Whole Health(y) Aging With Gerofit: The Development of a Pilot Wellness Program for Older Veterans.","authors":"Jamie Giffuni, Jeffrey Beans, Heidi Ortmeyer, Katherine S Hall, Morgan T Fique, Odessa Addison, Elizabeth A Dennis","doi":"10.12788/fp.0671","DOIUrl":"10.12788/fp.0671","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration (VHA) serves > 9 million veterans, half of whom are aged ≥ 65 years. Veterans are at higher risk for comorbidities, including obesity and related chronic diseases, which contribute to increased health care costs, mobility disability, poor quality of life, and mortality. Gerofit is a whole health clinical exercise program for older veterans that has positively impacted physical functioning, mental health, medication burden, and 10-year mortality. However, a more comprehensive wellness and health promotion program is essential for a rapidly aging veteran population.</p><p><strong>Observations: </strong>Whole Health(y) Aging with Gerofit expands upon the Gerofit exercise program by integrating additional wellness components from the VHA Whole Health Circle of Health framework. The program supplemented the Gerofit in-person and virtual exercise options with activities such as health education seminars, mindfulness yoga, nutrition classes, a produce pickup service, and companion dog fostering and adoption. The pilot program demonstrated that veterans actively participated in and benefited from a broader range of whole health activities beyond traditional exercise. Participant data, self-reported improvements in wellness, and positive feedback indicated engagement with multiple aspects of health, including physical, mental, and social well-being.</p><p><strong>Conclusions: </strong>Programs that target whole health are needed to ensure healthy aging. This pilot program provides an example of a comprehensive, patient-centered wellness model that empowers veterans to define and pursue their own wellness goals, supporting healthy aging across multiple domains.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Analysis of Biologic Use in the Treatment of Veterans With Hidradenitis Suppurativa.","authors":"Zachary Wendland, Katelyn Rypka, Lindsey Greenlund, Claire Herzog, Fatai Y Agiri, Amy A Gravely, Lauren Orenstein, Kathryn M Pridgen, Amit Garg, Julie A Lynch, Noah Goldfarb","doi":"10.12788/fp.0667","DOIUrl":"10.12788/fp.0667","url":null,"abstract":"<p><strong>Background: </strong>Biologic medications, such as adalimumab, secukinumab, and bimekizumab, are currently the only medications approved by the US Food and Drug Administration for the treatment of hidradenitis suppurativa (HS). Low rates of biologic use in HS have been reported, with significant differences in prescription patterns by sex, race, and age. However, no studies have analyzed these metrics in the Veterans Health Administration (VHA). This study evaluated HS therapy in the VHA and potential disparities in biologic prescription patterns for patients.</p><p><strong>Methods: </strong>This retrospective cross-sectional analysis used VHA data from January 1, 2011, to December 31, 2021. Biologic prescriptions, including adalimumab and infliximab, were analyzed across varying patient demographics and characteristics.</p><p><strong>Results: </strong>In VHA, 29,483 individuals had ≥ 1 diagnosis of HS, of whom 5.2% were prescribed ≥ 1 biologic (adalimumab or infliximab). Most patients diagnosed with HS were White (60.6%), men (75.3%), and obese (59.3%) and had prior or current tobacco use (73.5%). An age-dependent reduction in the odds of being prescribed a biologic in patients with HS (<i>P</i> < .001) was observed. Obesity (body mass index ≥ 30) significantly increased the odds of biologic prescription (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Biologic use in patients with HS was relatively low but higher or within the same range as previous studies. Understanding biologic prescription patterns offers potential to identify and improve access to underserved HS populations.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Brain Diagnostics: Advancing Precision Brain and Mental Health at the Department of Veterans Affairs.","authors":"Maya O'Neil, David Cameron, David X Cifu, Molly Sullan, Kate Clauss, William P Milberg, Catherine B Fortier, Elisabeth A Wilde, Ryan Holliday, Adam Kinney, Lisa A Brenner","doi":"10.12788/fp.0676","DOIUrl":"10.12788/fp.0676","url":null,"abstract":"<p><strong>Background: </strong>The <i>Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019</i> directs the US Department of Veterans Affairs Precision Medicine Initiative to identify and validate brain and mental health biomarkers related to the unique exposures and experiences of service members. Efforts are focused on individuals who served in combat to incorporate biopsychosocial factors into medical decision-making. At present, well-planned and reproducible data compilation, curation, and standardization are needed to harmonize data from varied sources.</p><p><strong>Observations: </strong>Harmonized data can facilitate precision care to improve veterans' brain and mental health. Longitudinal cohort studies of service members and veterans with military combat and training exposure histories provide researchers with access to biopsychosocial data shown to impact adverse health risks. Precision medicine efforts that incorporate biopsychosocial variables require the combination of such datasets because of the large sample sizes necessary for adequately powered multivariable analyses. The Total Brain Diagnostics (TBD) research team is harmonizing variables from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the Translational Research Center for TBI and Stress Disorders. Together, they contain prospective longitudinal data from > 4000 combat-exposed service members and veterans.</p><p><strong>Conclusions: </strong>Military service often results in unique exposures associated with brain and mental health disorders and functional impairment. To address clinical needs, the TBD team is creating a unified longitudinal dataset that combines measures from existing longitudinal protocols. Work by the TBD team may lay the foundation for using of prospective longitudinal datasets and linked large datasets to generate generalizable, clinically relevant information to advance precision brain and mental health care among service members and veterans. These efforts may facilitate precision prognostics, diagnostics, and tailored interventions, with potential benefits for the general population as well.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 2","pages":"56-61"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily Double! Assessing the Effectiveness of Game-Based Learning on the Pharmacy Knowledge of US Coast Guard Health Services Technicians.","authors":"Fengyee Zhou, Zachary Woodward, Xiaohong Huang","doi":"10.12788/fp.0659","DOIUrl":"10.12788/fp.0659","url":null,"abstract":"<p><strong>Background: </strong>US Coast Guard (USCG) corpsmen or health services technicians (HSs) serve in various medical support roles in USCG clinics and sick bays. To expand their medical knowledge, HSs complete formal and informal trainings and courses. USCG pharmacists routinely provide HSs with training designed to improve pharmacy knowledge. This study sought to describe the effectiveness of game-based learning on the pharmacy knowledge retention of HSs at 3 USCG clinics.</p><p><strong>Methods: </strong>In 2024, 28 HSs at 3 USCG clinics were provided a preintervention assessment consisting of 25 questions, completed a Jeopardy! style game-based activity, and completed the same assessment postintervention.</p><p><strong>Results: </strong>The mean preintervention score for the 25-question assessment was 15.1 (median, 15.0; mode, 10.0). Mean score increased to 17.4 (median, 17.5; mode, 24.0) postintervention. Formalized pharmacy training and more years of experience as an HS resulted in higher preintervention assessment scores compared with no formalized pharmacy training and fewer years of experience as an HS.</p><p><strong>Conclusions: </strong>In addition to traditional slide-based trainings, game-based learning can create engaging learning environments that support knowledge retention of pharmacy and other medical topics for USCG corpsmen.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Lumbar Fusion and Dual-Mobility Liners on Dislocation Rates Following Total Hip Arthroplasty in a Veteran Population.","authors":"Andrew J Stiene, Brandon S Zakeri, John Paul M Angeles, Nickolas A Stewart, Andrew W Froehle, Anil B Krishnamurthy","doi":"10.12788/fp.0665","DOIUrl":"10.12788/fp.0665","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a common orthopedic procedure, particularly in the US veteran population. Dislocation is a significant complication, influenced by such factors as lumbar spinal fusion (LSF), which may be more prevalent in veterans due to service-related injuries. This 20-year retrospective study investigated the association between LSF and dislocation risk in veterans who underwent THA; it also explored the impact of dual-mobility liners on dislocation rates.</p><p><strong>Methods: </strong>THA procedures performed by a single surgeon from 2003 to 2022 were reviewed. The primary outcome was dislocation within 1 year of primary THA; revision rates were a secondary measure. The study evaluated relationships between LSF, demographic variables, the Charlson Comorbidity Index, and lumbar levels that were fused. The study also reviewed whether the use of dual-mobility liners was linked to any protective effects in patients with THA who had previous LSF.</p><p><strong>Results: </strong>The study included 967 THAs for 852 patients; 39 patients (42 THAs) had a prior LSF. Dislocation rates were 9.5% for those with LSF and 3.8% for those without LSF. Logistic regression analysis revealed 2 factors associated with a significantly increased risk of dislocation within 1 year of THA: female sex (odds ratio [OR], 5.84; 95% CI, 2.60-13.13; <i>P</i> < .001) and LSF (OR, 3.42; 95% CI, 1.12-10.47; <i>P</i> = .03). None of the 16 patients treated with a dual-mobility liner experienced dislocation.</p><p><strong>Conclusions: </strong>This 20-year retrospective study involving a veteran population and a single surgeon identified a heightened risk of postoperative dislocation within 1 year of THA among female patients and those with prior LSF. Findings also suggest that dual-mobility liners may be protective against postoperative dislocation in individuals with a history of LSF.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"10-14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of an Administrative Algorithm to Identify Veterans With Epilepsy.","authors":"Rizwana Rehman, Zulfi Haneef, Sheela Sajan, Alfred Frontera, Maria R Lopez, Stephan Eisenschenk, Tung Tran","doi":"10.12788/fp.0660","DOIUrl":"10.12788/fp.0660","url":null,"abstract":"<p><strong>Background: </strong>Accurate epilepsy identification in large health care systems has the potential to improve health care delivery and resource allocation. This article summarizes the creation and validation of a 3-tiered algorithm to identify veterans with epilepsy (VWE) receiving care from the Veterans Health Administration (VHA) using administrative data.</p><p><strong>Methods: </strong>A 3-tier algorithm was developed to identify patients with epilepsy utilizing <i>International Classification of Diseases</i> diagnosis codes and prescription data. Tier 1 integrates seizure-specific diagnostic codes and antiseizure medication data. Tier 2 includes patients with inpatient visits. Tier 3 identifies untreated or less obvious cases by including patients with multiple outpatient visits. VHA administrative databases linked to the VHA Corporate Data Warehouse were used to identify VWE. Tier 1 validation was based on 625 patients and Tiers 2 and 3 validation was based on 300 total patients. Validation was conducted by expert epilepsy clinicians (epileptologists and a nurse care coordinator) comparing algorithm classifications against the International League Against Epilepsy definition of epilepsy to ascertain positive predictive values (PPVs). Annual trends for the number of VWE cases identified by the algorithm within the VHA are also presented.</p><p><strong>Results: </strong>Tier 1 demonstrated a PPV of 85.1% (95% CI, 82.1%-87.8%). Tiers 2 and 3 offered broader identification and had lower PPVs: Tier 2 PPV was 61.9% (95% CI, 53.4%-70.4%) and Tier 3 PPV was 59.8% (95% CI, 52.5%-67.1%).</p><p><strong>Conclusions: </strong>By efficiently segmenting veterans based on reliable administrative data, this 3-tiered algorithm supports enhanced surveillance, targeted health care provision, and optimal resource utilization. Though it is tailored to the VHA, this algorithmic approach holds promise for broader application in health care systems facing similar epidemiologic and administrative challenges.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"22-27"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Clinician and Patient Knowledge, Interest, and Use of Integrative Treatment Options for Chronic Low Back Pain Management.","authors":"Meera Ronfeldt, Rachael Maciasz, Nikhil Navathe, Kennedy Dubose, Sarah L Krein","doi":"10.12788/fp.0670","DOIUrl":"10.12788/fp.0670","url":null,"abstract":"<p><strong>Background: </strong>Access to effective nonpharmacologic treatments for chronic pain, including integrative therapy approaches, is a priority for the US Department of Veterans Affairs (VA) for improving pain care and promoting patient-centered care as part of the VA Whole Health System care delivery model. This study sought to assess primary care practitioner (PCP) and patient knowledge, interest, and use of integrative therapies to identify strategies to promote broader utilization.</p><p><strong>Methods: </strong>PCPs affiliated with the VA Ann Arbor Healthcare System and a random sample of patients with low back pain diagnoses were surveyed. These cross-sectional surveys assessed knowledge, use, interest, and perceived barriers.</p><p><strong>Results: </strong>Twenty-eight PCPs and 83 patients completed the survey, yielding response rates of 36% and 42%, respectively. Twenty-three PCPs (82%) reported recommending cognitive-behavioral therapy, 22 (79%) recommended acupuncture, and 21 (75%) chiropractic modalities for chronic pain. Fifty-nine patients (71%) reported using chiropractic and 42 (51%) used acupuncture therapies. Acupuncture, chiropractic and massage were identified as therapies that most PCPs and patients would like to have available. Twenty-six PCPs (93%) identified access to services, 22 (79%) cited time constraints, 17 (61%) cited lack of familiarity, and 18 (64%) cited lack of evidence as barriers to offering integrative therapies. Patient-identified barriers to using therapies included not knowing what services were available at their facility, not being familiar with a specific therapy, and lack of clarity about the benefits of a specific therapy.</p><p><strong>Conclusions: </strong>VA PCPs and patients with chronic back pain have some experience with and are interested in using specific integrative therapies. Barriers such as service accessibility and knowledge gaps must be addressed to increase the uptake of integrative modalities for managing chronic pain.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"32-37"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confronting Uncertainty and Addressing Urgency for Action Through the Establishment of a VA Long COVID Practice-Based Research Network.","authors":"Allison M Gustavson, Alicia B Woodward-Abel, Tammy L Eaton, Troy Layouni, Sena Soleimannejad, Carla Amundson, Emily Hudson, Megan Miller, Collin Calvert, Marianne Goodman, Timothy J Wilt, Norbert Bräu, Kristina Crothers, R Adams Dudley, Aaron P Turner","doi":"10.12788/fp.0669","DOIUrl":"10.12788/fp.0669","url":null,"abstract":"<p><strong>Background: </strong>Learning health systems (LHS) show promise in making sense of uncertainty and emerging evidence in complex conditions. Long COVID challenges how care is delivered. The Veterans Health Administration has funded a Long COVID Practice-Based Research Network (LC-PBRN) to create an LHS-based infrastructure to promote interdisciplinary collaboration (eg, multidisciplinary clinicians, researchers, operational partners, policymakers, and intra-agency workgroups).</p><p><strong>Observations: </strong>This article describes the LC-PBRN model, outlines associated lessons learned, and provides suggestions to assist with future PBRN implementations. Lessons learned include incorporating veterans' voices to ensure network efforts align with patient needs, developing an interdisciplinary leadership team to foster diverse viewpoints, setting clear expectations and goals with partners, and building engaging relationships to bridge gaps between internal and external partners.</p><p><strong>Conclusions: </strong>The LC-PBRN experience can inform the evolving role of other PBRNs as an integral part of building and sustaining LHS infrastructure.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Codes, Contracts, and Commitments: Who Defines What is a Profession?","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0672","DOIUrl":"10.12788/fp.0672","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"43 1","pages":"8-9"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Telehealth Improve Access to Amyloid-Targeting Therapies for Veterans Living With Alzheimer Disease?","authors":"Alison J O'Donnell, Steven M Handler, Julie Faieta, Robin Jump","doi":"10.12788/fp.0656","DOIUrl":"10.12788/fp.0656","url":null,"abstract":"<p><strong>Background: </strong>Amyloid-targeting therapies, such as lecanemab and donanemab, offer new hope for managing Alzheimer disease (AD). Provision of these medications, however, is challenging for patients, care partners, and clinicians.</p><p><strong>Observations: </strong>Telehealth has demonstrated success in the assessment and management of individuals living with dementia in the Veterans Health Administration (VHA). It may substantially increase access to evaluation for veterans with early dementia and, when medically appropriate, amyloid-targeting therapies. Telehealth has the potential to overcome barriers related to transportation, access to specialists, and relieve the burden of frequent clinical assessments, as well as associated costs. Although telehealth is not without limitations, VHA is a leader in telehealth and has taken action to overcome patient barriers related to the digital divide.</p><p><strong>Conclusions: </strong>The VHA is well-positioned to use a hybrid approach-both telehealth and in-person care-to support the provision of amyloid-targeting therapies for veterans with AD. Lessons learned can be extended to non-VHA care settings to achieve potential benefits for other patients with early AD.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"42 12","pages":"458-462"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}